Your pictures look like a Diastasis Recti without an obvious hernia. You would be the perfect candidate for a tummy tuck by a board certified plastic surgeon since you also have loose stretched out skin. That's not unexpected in a petite woman with large babies.
Is diastasis recti repair possible without surgery?
Your may wish to investigate the Kupler Technique a non-invasive technique to correct your diastasis recti. Your pictures indicate you would be an excellent candidate for the Kupler Technique. If an umbilical hernia is still present after the diastasis recti correction with the Kupler Technique, you could consult a general surgeon for repair options. Your umbilical hernia probably could be corrected with a laparoscopic procedure using tiny incisions.
Hernia repairs and diastasis recti repairs
The large vertical bulge appears to be the diastasis to which you're referring. You sound as if you understand that a diastasis is not a true hernia, and that you have a separate hernia elsewhere. If it's an umbilical hernia, it is repaired when an abdominoplasty is done, and the rectus diastasis is repaired as well. All these are done as part of an abdominoplasty. The recovery from a tummy tuck really has to do with the muscle part of the surgery, so it makes the most sense to have the full tummy tuck and remove all the extra, loose skin.
Tummy tuck with hernia and rectus diastasis
Hi. Yes, it is possible to have a hernia repair without repairing a diastasis. And, yes, a general surgeon can do that. BUT, combining this with a tummy tuck would likely fix all that is necessary AND give you a much better cosmetic outcome (which may not occur if all of the issues aren't fixed and if a general surgeon performs a midline scar repair). Also, it is possible that the bulge that you have may not be a true hernia, so getting into a plastic surgeon's office for an exam would be the best first step. Best of luck!
Hernia of abdominal wall or Diastasis?
A hernia is a hole in the abdominal wall where intestine or fatty tissue below the muscle can protrude and possibly get trapped. If intestine gets trapped in the hernia, emergency medical attention is required. A diastasis is stretching of the abdominal wall tissue but there is no hole present. The tissue can become very thin and bulge as in your photo. Therefore, a hernia and a diastasis are two different problems. Have an evaluation by a board certified plastic surgeon who will refer you to a general surgeon if a hernia is also present. Both issues can be addressed at the same surgical procedure.
Your photos seem to show disastasis not a hernia. Given your skin and abdomen anatomy the clear correct answer is abdominoplasty. The repair of your muscles and skin may well solve your back pain as well.
A general surgeon repair is not the best choice. That will leave you with a long vertical scar.
See a board certified plastic surgeon. Don't skimp on this one. You should get a great result.